Acne is the most common skin condition in the United States. To first understand acne, we will review the components of a pilosebaceous unit. A pilosebacous unit consists of a pore opening, hair root and bulb, and a sebaceous (oil) gland and duct. The oil from the sebaceous gland is called sebum and it’s the skin’s natural oil to help keep the skin supple and healthy. Normally, sebum is excreted from the gland into the pore and dead skin cells shed into the pore as well. The sebum and dead skin cells emerge onto the skin surface at the pore’s opening.
When the sebaceous gland or duct becomes blocked with a combination of sebum and dead skin cells, they build up and it forms a hard plug that blocks the pore from opening. This leads to whiteheads and blackheads.
A whitehead is called a “closed comedone” and it is when the oil gland is filled with sebum and dead skin cells, but the opening to the surface of the skin is still covered.
A blackhead is also called an “open comedone” and it is when an oil gland that is filled with sebum and dead skin cells is open to the surface, which forms a black appearing spot on the skin.
When whiteheads and blackheads occur, it provides a favorable environment for some changes in the microbiome of the skin. In these conditions, a bacteria called Propionibacterium acnes (P. acnes) that is normally found on the skin, begins to grow out of control. When there is an overgrowth of P. acnes, white blood cells rush to fight the overgrowth and the skin swells and this leads to inflammatory acne lesions. Inflammatory pustules and papules develop when there is inflammation, redness and swelling of the clogged pore.
When inflammatory papules are deeper and are mostly under the surface of the skin they are considered cysts and large cysts are referred to nodules.
The type of acne lesions you have guides your treatment options. Please see your integrative dermatologist to discuss what treatment modalities fit best for you.